Overdose death rates in the U.S. increased dramatically in 2020 as the Covid-19 pandemic arrived, especially among Black, American Indian and Alaska Native individuals, according to a new report from the Centers for Disease Control and Prevention, as deadly synthetic opioids flooded the nation and access to treatment remained elusive for millions of Americans.
The rates rose 44 percent in 2020 for Black people and 39 percent for American Indian and Alaska Native people, compared to 22 percent for white people.
The CDC report, which analyzed data from 25 states and the District of Columbia, underscores how the opioid epidemic driving those deaths has spread from predominantly white rural areas into communities of color, becoming more entrenched along racial and ethnic lines as both barriers to substance abuse treatment and treatment biases persist.
“Racism — a root cause of health disparities — continues to be a serious public health risk that directly affects the wellbeing of millions of Americans, and as a result, affects the health of our entire nation,” said Debra Houry, the CDC’s acting principal deputy director and director of the agency’s National Center for Injury Prevention and Control in a briefing on Tuesday.
The crisis is disproportionately affecting Black Americans at both ends of life. Black youth aged 15 to 24 saw an 86 percent increase in overdose deaths, the largest spike of any age or race group, while Black men 65 and older were nearly seven times as likely to die from an overdose as white men.
At the same time, access to treatment for substance abuse is deeply skewed. Black people were less than half as likely as white people to have received substance use treatment, the report found.
And in areas where there were more opioid treatment programs available, opioid overdose rates were even higher than in areas with lower treatment availability, particularly among Black, American Indian and Alaska Native persons.
“Just because there's availability of services doesn't mean those services are actually accessible,” said Mbabazi Kariisa, a health scientist with the CDC’s Division of Overdose Prevention during the briefing.
After President Donald Trump declared the opioid crisis a national health emergency in 2017, drug overdose deaths in the U.S. have continued to climb, hitting record highs in 2020 and 2021, with 91,799 and an estimated 107,622 deaths, respectively. Overdose deaths involving opioids accounted for the vast majority.
The pandemic, which drove people into social isolation and away from health care, appears to have further exacerbated the problem.
The opioid crisis has shifted dramatically from its early days of prescription drug abuse to people often unknowingly taking powerful synthetic fentanyl produced by transnational criminal organizations that has been mixed with other drugs, including cocaine, said Rahul Gupta, director of the White House Office of National Drug Control Policy, in an interview with POLITICO.
“This is not your uncle's or your grandmother's opioid crisis,” he said. The proliferation of synthetic fentanyl has made drugs more unpredictable, he said, and “is devastating communities and killing Americans.”
Houry said that raising Americans’ awareness about the dangers of the illicit drug supply in culturally appropriate campaigns will be critical to battling the trends in overdose deaths, as well as continuing to try to improve access to treatment for all groups impacted by substance use disorder.
The CDC pointed to a host of ways that barriers to treatment for substance use access can play out in people’s lives, ranging from logistical issues such as insurance coverage and the geographic distribution of treatment centers to more deep-seated problems like the persistent stigmatization of substance use and long-running distrust of the health care system.
“There are a number of things that play a role, beyond just the availability of treatment services in a particular town or area, that further prevents [people] from accessing those resources,” said Kariisa.